المؤلفون: Sunkara, Sesh Kamal¹ sesh.sunkara1@nhs.net, LaMarca, Antonio², Polyzos, Nikolaos P.³, Seed, Paul T.⁴, Khalaf, Yakoub⁵

المصدر: Human Reproduction. Oct2016, Vol. 31 Issue 10, p2261-2267. 7p. 1 Diagram, 2 Charts, 2 Graphs.

مصطلحات موضوعية: *CHILDBIRTH, *PREMATURE labor, *PREGNANCY complications, *FERTILIZATION in vitro, *HEALTH outcome assessment, *LOW birth weight, *BIRTH rate, *GESTATIONAL age, *PREMATURE infants, *EVALUATION of medical care, *INDUCED ovulation, *PREGNANCY, PERINATAL care

مستخلص: Study Question: Does ovarian stimulation affect perinatal outcomes of preterm birth (PTB) and low birth weight (LBW) following IVF treatment.Summary Answer: Despite no significant differences in the risks of PTB and LBW between stimulated and unstimulated IVF in the present study, the study cannot exclude the effect of ovarian stimulation on the perinatal outcomes following IVF.What Is Already Known: Pregnancies resulting from assisted reproductive treatments (ART) are associated with a higher risk of pregnancy complications compared to spontaneously conceived pregnancies attributed to the underlying infertility and the in vitro fertilization techniques. It is of interest to determine the effect size of ovarian stimulation use in achieving a live birth and whether ovarian stimulation that is routinely used in IVF, affects perinatal outcomes of birth weight and gestational age at delivery compared to unstimulated IVF.Study Design, Size, Duration: Anonymous data were obtained from the Human Fertilisation and Embryology Authority (HFEA), the statutory regulator of ART in the UK. The HFEA has collected data prospectively on all ART performed in the UK since 1991. Data from 1991 to 2011 comprising a total of 591 003 fresh IVF ± ICSI cycles involving 584 835 stimulated IVF cycles and 6168 unstimulated IVF cycles were analyzed.Participants/materials, Setting, Methods: Data on all women undergoing either stimulated or unstimulated fresh IVF ± ICSI cycles during the period from 1991 to 2011 were analyzed to compare live birth rates, singleton live birth rates, perinatal outcomes of PTB, early PTB (<32 weeks), LBW and very LBW (<1500 grams) among singleton live births. Adjusted logistic regression was performed for each perinatal outcome for confounding factors: female age, period of treatment, cause of infertility, number of previous IVF cycles and previous live birth.Main Results and the Role Of Chance: Analysis of the large nationwide data demonstrated 3.5 times (95% confidence interval (CI): 3.1-3.9) as many unstimulated IVF cycles being required to achieve one live birth compared to stimulated IVF and 2.9 times (95% CI: 2.6-3.2) as many unstimulated IVF cycles being required to achieve one singleton live birth compared to stimulated IVF. There was no significant difference in the unadjusted odds for PTB (odds ratio (OR) 1.27, 95% CI: 0.80-2.00) and LBW (OR 1.48, 95% CI: 0.90-2.42) between stimulated and unstimulated IVF cycles. There was no significant difference in the risk of the adverse perinatal outcomes after adjusting for potential confounders; PTB (adjusted odds ratio (aOR) 1.43, 95% CI: 0.91-2.26) and LBW (aOR 1.58, 95% CI: 0.96-2.58).Limitations, Reasons For Caution: Although the analysis was adjusted for a number of important confounders, the dataset had no information on smoking, body mass index (BMI) and the medical history of women during pregnancy to allow adjustment. Anonymized nature of the dataset did not make it permissible to analyse one cycle per woman. Given the smaller number of perinatal events with unstimulated IVF, a larger study is needed to investigate further.Wider Implications Of the Findings: Analysis of this large dataset demonstrates that ovarian stimulation has a vital role in maximizing efficacy of IVF. Although there were no significant differences for PTB and LBW following stimulated compared to unstimulated IVF, the CIs were wide enough to include possible clinically important effects.Study Funding/competing Interests: No funding was obtained. There are no competing interests to declare. [ABSTRACT FROM AUTHOR]

المؤلفون: Sunkara, Sesh Kamal¹ sksunkara@hotmail.com, La Marca, Antonio², Seed, Paul T.³, Khalaf, Yacoub³

المصدر: Human Reproduction. Jun2015, Vol. 30 Issue 6, p1473-1480. 8p. 1 Diagram, 5 Charts, 2 Graphs.

مصطلحات موضوعية: *RISK factors in premature labor, *PREGNANCY complications, *BIRTH weight, *PREMATURE infants, *HUMAN in vitro fertilization, *CHILDBIRTH, *OVUM, *HEALTH outcome assessment

مستخلص: STUDY QUESTION: Is there a relation between the number of oocytes retrieved following ovarian stimulation and obstetric outcomes of preterm birth (PTB) and low birthweight (LBW) following IVF treatment? SUMMARY ANSWER: There is an increased risk of PTB (<37 weeks gestation) and LBW (<2500 g) following IVF in women with a high number (>20) of oocytes retrieved. WHAT IS KNOWN ALREADY: Pregnancies resulting from assisted reproductive treatments (ART) are associated with a higher risk of pregnancy complications compared with spontaneously conceived pregnancies. Whether ovarian ageing in women with poor ovarian response is associated with an increased risk of adverse obstetric outcomes is debated. It is also unclear if an excessive response and high egg numbers following ovarian stimulation have an association with adverse obstetric outcomes. STUDY DESIGN, SIZE, DURATION: Observational study using anonymized data on all IVF cycles performed in the UK from August 1991 to June 2008. Data from 402 185 IVF cycles and 65 868 singleton live birth outcomes were analysed. PARTICIPANTS/MATERIALS, SETTING, METHODS: Data on all women undergoing a stimulated fresh IVF cycle with at least one oocyte retrieved between 1991 and June 2008 were analysed for birth outcomes. Logistic regression analysis of the association between ovarian response (quantified as number of oocytes retrieved) and outcomes of PTB and LBW was performed. MAIN RESULTS AND THE ROLE Of CHANCE: There was a significantly higher risk of adverse obstetric outcomes of PTB and LBW among women with an excessive response (>20 oocytes) compared with women with a normal response (10-15 oocytes): adjusted odds ratio (OR) 1.15, 95% confidence interval (CI) 1.03-1.28 for PTB, adjusted OR 1.17, 95% CI 1.05-1.30 for LBW, respectively. There was no increased risk of the adverse outcomes among women with a poor ovarian response (≤3 oocytes) compared with women with a normal response: adjusted OR0.88, 95% CI 0.76- 1.01 for PTB, adjusted OR0.92, 95% CI 0.79-1.06 for LBW, respectively. LIMITATIONS, REASONS FOR CAUTION: Although the analysis was adjusted for a number of potential confounders, the dataset had no information on other important confounders such as smoking, BMI and the medical history of women during pregnancy. Furthermore, the dataset did not allow specific identification of women with PCOS and its anonymized nature did not make it permissible to analyse one cycle per woman. WIDER IMPLICATIONS Of THE FINDINGS: Analysis of this large dataset suggests that a high oocyte number (>20) following IVF is associated with a higher risk of PTB and LBW. These findings lead to speculation whether ovarian dysfunction and/or an altered endometrial milieu resulting from supraphysiological steroid levels underlie the unfavourable outcomes and warrant further research. Ovarian stimulation regimens should optimize the number of oocytes retrieved to avoid the risk of adverse outcomes associated with very high numbers of oocytes. STUDY FUNDING/COMPETING INTEREST(S): No funding was obtained. There are no competing interests to declare. [ABSTRACT FROM AUTHOR]

العنوان البديل: Tabagismo e outros fatores de risco prégestacional para nascimento espontâneo prematuro.

المؤلفون: Grillo, Eugênio¹, Freitas, Paulo Fontoura² pfreitas.epidemio@gmail.com

المصدر: Brazilian Journal of Mother & Child Health (BJMCH) / Revista Brasileira de Saude Materno Infantil (RBSMI). out-dez2011, Vol. 11 Issue 4, p397-403. 7p.

مصطلحات موضوعية: *RISK factors in premature labor, *CHILDBIRTH, *PRENATAL tobacco exposure, *GESTATIONAL age, *HEALTH outcome assessment, *LOGISTIC regression analysis

الملخص (بالإنجليزية): Objectives: to investigate pre-gestational risk factors for spontaneous preterm birth and, the role of smoking and its cumulative effects on prematurity. Methods: a case-control study analyzed a data set of all births occurring in a tertiary maternity hospital between April 2002 and July 2004. Spontaneous preterm births of single and live newborns without malformations were selected as cases. Controls were all the term births of live and single newborns without malformations during the same period. Three Outcomes were studied: all preterm births (<37 weeks), less than 35 weeks and less than 32 weeks of gestational age. Logistic regression was used to obtain the independent effect of pre-gestational risk factors. Results: maternal age of less than 20 years, low schooling, low maternal pre-gestational body mass index and smoking showed significant, independent association with spontaneous preterm birth for the three outcomes. For all these risk factors, excepting maternal smoking, odds ratios increased with decreasing gestational age at birth and this trend was significant for low maternal age and low pre-gestational body mass index. Conclusions: the cumulative effects of smoking calls for the need to encourage smoking cessation among pregnant women, especially those who are underweight and in the older age groups, because of the increased risk of delivering premature babies. [ABSTRACT FROM AUTHOR]

Abstract (Portuguese): Objetivos: investigar fatores de risco pré-gestacional para nascimento espontáneo prematuro e o papel do tabagismo e seus efeitos cumulativos na prematuridade. Métodos: um estudo transversal baseado em um banco de dados maternos e perinatais, analisou todos os nascimentos ocorridos, em um hospital terciário, no periodo de abril de 2002 a julho de 2004. Nascimentos prematuros, únicos e espontáneos, de nascidos vivos, sem malformações, foram selecionados como casos. Controles foram selecionados como nascidos vivos e a termo, únicos e sem malformaçöes durante o mesmo periodo. Trés desfechos foram estudados: todos nascimentos prematuros com menos de 37 semanas, aqueles com menos de 35 e 32 semanas de gestação. Regressão Logistica foi utilizada na determinação do efeito independente de cada um dos fatores de risco. Resultados: idade materna de menos de 20 anos, baixa escolaridade, baixo indice de massa corporal pré-gestacional e tabagismo se mostraram independente e significativamente associados com nascimento espontãneo e prematuro para os trés desfechos. Para todos os fatores de risco, exceto tabagismo materno, as razões de chance aumentaram linearmente com o decréscimo da idade gestacional. O teste para tendéncia linear se mostrou significante para idade materna de menos de 20 anos e para baixo indice de massa corporal pré-gestacional. Conclusões: os efeitos cumulativos do tabagismno apontam para a necessidade de incentivar o abandono do hábito de fumar entre as gestantes, especialmente entre aquelas com baixo indice de massa corporal e em idade mais avançada, devido ao risco aumentado de prematuridade neste grupo especifico. [ABSTRACT FROM AUTHOR]

المؤلفون: Sosta, Elena¹, Tomasoni, Lina R.², Frusca, Tiziana³, Triglia, Maria³, Pirali, Francesco⁴, El Hamad, Issa², Castelli, Francesco

المصدر: Journal of Travel Medicine. Jul/Aug2008, Vol. 15 Issue 4, p243-247. 5p. 2 Charts.

مصطلحات موضوعية: *PREMATURE infants, *PREMATURE labor, *CHILDBIRTH, *HEALTH of immigrants, *RISK assessment, *HEALTH outcome assessment

مصطلحات جغرافية: ITALY

مستخلص: Background. Various studies have ascertained different birth outcomes between resident and migrant populations in western countries. Considering preterm delivery (<37 complete weeks of gestation) as a perinatal risk condition, we assessed its rate in migrant and native Italian women who delivered in the main public hospital in Brescia (Italy). Methods. All migrant puerperas and a random sample of native puerperas hospitalized during the period February to May 2005 were included in the study after informed consent and filled in a self-administered multilanguage questionnaire enquiring about sociodemographic and obstetric data. Additional information including last menstrual period was obtained from personal obstetric records. Results. As many as 471 puerperas entered the study: 366 Italian and 105 migrant women coming from eastern Europe (41.9%), Asia (20%), South America (10.5%), and Africa (27.6%). Of the migrant population, 67 of 105 (63.8%) were at their first delivery in Italy (median interval from arrival: 3.8 y). Gestational age at delivery was assessed for 456 of 471 women (103 migrants and 353 Italians). A total of 36 (7.9%) preterm deliveries were registered: 22 (6.2%) in Italian and 14 (13.6%) in migrant puerperas ( p value = 0.015). The highest preterm delivery rate was observed in African women (20.7%), while women from eastern Europe had a similar rate to Italians. In univariate analysis, factors associated to preterm delivery were parity and length of permanence in Italy. We could not demonstrate any correlation with smoking or with a delayed access to antenatal care (first obstetric evaluation after 12 complete weeks of gestation). In multivariate analysis, African origin was the only independent risk factor for preterm delivery [odds ratio (OR) = 3.54; p = 0.018]. Conclusions. In our setting, preterm delivery occurred more frequently in migrant women, particularly of African origin, and it is not associated to delayed access to antenatal care. [ABSTRACT FROM AUTHOR]

المؤلفون: de Heus, Roel¹ R.deHeus-2@umcutrecht.nl, Mol, Ben Willem^2,3, Erwich, Jan-Jaap H.M.⁴, van Geijn, Herman P.⁵, Gyselaers, Wilfried J.⁶, Hanssens, Myriam⁷, Härmark, Linda⁸, van Holsbeke, Caroline D.⁶, Duvekot, Johannes J.⁹, Schobben, Fred F.A.M.¹⁰, Wolf, Hans³, Visser, Gerard H.A.¹

المصدر: BMJ: British Medical Journal (Overseas & Retired Doctors Edition). 3/28/2009, Vol. 338 Issue 7697, p758-760. 3p. 1 Chart.

مصطلحات موضوعية: *RISK factors in premature labor, *DELIVERY (Obstetrics), *CHILDBIRTH, *PREMATURE labor, *PREGNANCY complications, *DRUG side effects, *PRENATAL care, *HEALTH outcome assessment, *NIFEDIPINE, *COMORBIDITY, *MANAGEMENT, *PHYSIOLOGY, *THERAPEUTICS

مستخلص: Objective To evaluate the incidence of serious maternal complications after the use of various tocolytic drugs for the treatment of preterm labour in routine clinical situations. Design Prospective cohort study. Setting 28 hospitals in the Netherlands and Belgium. Participants 1920 consecutive women treated with tocolytics for threatened preterm labour. Main outcome measures Maternal adverse events (those suspected of being causally related to treatment were considered adverse drug reactions) leading to cessation of treatment. Results An independent panel evaluated the recorded adverse events, without knowledge of the type of tocolytic used. Of the 1920 women treated with tocolytics, 1327 received a single course of treatment (69.1%), 282 sequential courses (14.7%), and 311 combined courses (16.2%). Adverse drug reactions were categorised as serious or mild in 14 cases each. The overall incidence of serious adverse drug reaction was 0.7%. Compared with atosiban, the relative risk of an adverse drug reaction for single treatment with a ß adrenoceptor agonist was 22.0 (95% confidence interval 3.6 to 138.0) and for single treatment with a calcium antagonist was 12 (1.9 to 69). Multiple drugtocolysis led to five serious adverse drug reactions (1.6%). Multiple gestation, preterm rupture of membranes, and comorbidity were not independent risk factors for adverse drug reactions. Conclusions The use of ß adrenoceptor agonists or multiple tocolytics for preventing preterm birth is associated with a high incidence of serious adverse drug reactions. Indometacin and atosiban were the only drugs not associated with serious adverse drug reactions. A direct comparison of the effectiveness of nifedipine and atosiban in postponing preterm delivery is needed. [ABSTRACT FROM AUTHOR]

المؤلفون: Ludvigsson, Jonas, Neovius, Martin, Stephansson, Olof, Hammarström, Lennart

المصدر: Journal of Clinical Immunology; Oct2014, Vol. 34 Issue 7, p853-863, 11p

مصطلحات موضوعية: IMMUNOGLOBULIN A, PREGNANCY, AUTOIMMUNE diseases, UNIVERSITY hospitals, PREMATURE labor, HEALTH outcome assessment

مستخلص: Background: Several autoimmune disorders have been linked to adverse pregnancy outcome. IgA deficiency shares many autoimmune traits, but its association with pregnancy outcome is unknown. Methods: Prospective population-based cohort study in Sweden of 613 mothers with IgA deficiency (IgA levels < .07 g/L) diagnosed in 1980-2010 in six university hospitals. In 1973-2010, these women delivered 1,172 singleton infants registered in the Swedish Medical Birth Register. Each delivery to a woman with IgA deficiency was matched on maternal age, parity, early pregnancy smoking status, education level, and delivery year with up to 5 control births ( n = 5,758). Results: Offspring to women with IgA deficiency had 79 g lower birth weight than controls (mean ± SD: 3,457 ± 559 vs 3,537 ± 553 g, P < 0.001), and 1.4 days shorter gestational age (mean ± SD: 278 ± 13 vs 280 ± 14 days, P = 0.001). No difference in preterm birth (<37 weeks) could be detected in deliveries to women with IgA deficiency vs control deliveries (5.8 % vs 5.2 %; odds ratio (OR) = 1.13, 95%CI = 0.85-1.49), but small for gestational age birth was more common (4.3 % vs 2.8 %; OR = 1.48, 95%CI = 1.04-2.10). Women with IgA deficiency also delivered more often by caesarean section (16.9 % vs 11.9 %; OR = 1.51, 95%CI = 1.26-1.82), while no difference was observed regarding low Apgar score (<7 at 5 min; 1.1 % vs 1.0 %; OR = 1.18; 95%CI = 0.62-2.27). When excluding women with autoimmune diseases, the excess risks of adverse pregnancy outcome diminished. Conclusion: There is a small excess risk of certain adverse delivery and perinatal outcomes among offspring to women with IgA deficiency. These excess risks are attenuated when considering the presence of autoimmune diseases. [ABSTRACT FROM AUTHOR]

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المؤلفون: Zhong-Cheng Luo, Senécal, Sacha, Simonet, Fabienne, Guimond, Éric, Penney, Christopher, Wilkins, Russell

المصدر: Canadian Medical Association Journal (CMAJ); 2/23/2010, Vol. 182 Issue 3, p235-242, 8p, 1 Diagram, 4 Charts, 1 Graph

مصطلحات موضوعية: CHILDBIRTH, HEALTH outcome assessment, SUDDEN infant death syndrome, PREMATURE labor, CONFIDENCE intervals, INUIT

مصطلحات جغرافية: CANADA

مستخلص: Background: Information on health disparities between Aboriginal and non-Aboriginal populations is essential for developing public health programs aimed at reducing such disparities. The lack of data on disparities in birth outcomes between Inuit and non-Inuit populations in Canada prompted us to compare birth outcomes in Inuit-inhabited areas with those in the rest of the country and in other rural and northern areas of Canada. Methods: We conducted a cohort study of all births in Canada during 1990-2000 using linked vital data. We identified 13 642 births to residents of Inuit-inhabited areas and 4 054 489 births to residents of all other areas. The primary outcome measures were preterm birth, stillbirth and infant death. Results: Compared with the rest of Canada, Inuit- inhabited areas had substantially higher rates of preterm birth (risk ratio [RR] 1.45, 95% confidence interval [CI] 1.38-1.52), stillbirth (RR 1.68, 95% CI 1.38-2.04) and infant death (RR 3.61, 95% CI 3.17-4.12). The risk ratios and absolute differences in risk for these outcomes changed little over time. Excess mortality was observed for all major causes of infant death, including congenital anomalies (RR 1.64), immaturityrelated conditions (RR 2.96), asphyxia (RR 2.43), sudden infant death syndrome (RR 7.15), infection (RR 8.32) and external causes (RR 7.30). Maternal characteristics accounted for only a small part of the risk disparities. Substantial risk ratios for preterm birth, stillbirth and infant death re mained when the comparisons were restricted to other rural or northern areas of Canada. Interpretation: The Inuit-inhabited areas had much higher rates of preterm birth, stillbirth and infant death compared with the rest of Canada and with other rural and northern areas. There is an urgent need for more effective interventions to improve maternal and infant health in Inuit-inhabited areas. [ABSTRACT FROM AUTHOR]

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المؤلفون: Tough, Suzanne, Fraser-Lee, Nonie, Benzies, Karen, Faber, Alexandra, Newburn-Cook, Christine, Sauve, Reg, Tofflemire, Karen

المصدر: Canadian Journal of Public Health; Jul/Aug2006, Vol. 97 Issue 4, p330-334, 5p

مصطلحات موضوعية: PREGNANCY complications, CHILDBIRTH, PREMATURE labor, HEALTH outcome assessment, BIRTH weight, COMPUTER assisted research

مصطلحات جغرافية: CANADA

الملخص (بالإنجليزية): Background: Women aged 35 and older account for an increasing proportion of births and are at increased risk of pregnancy complications and poor infant outcomes. The objectives of the study were: 1) to determine what women know about delayed childbearing, including pregnancy complications and outcomes associated with low birthweight (LBW, <2500 grams), preterm delivery (<37 weeks) and multiple birth, and 2) to assess the characteristics of women with limited knowledge of risks. Methods: A computer-assisted telephone interview survey was conducted with 1,044 randomly selected women who delivered their first live-born infant, between July 2002 and September 2003, in two urban centres, Calgary and Edmonton, in Alberta, Canada. Results: The proportion of women aware of specific childbearing risks associated with advanced maternal age were as follows: conception difficulties (85.3%), multiple birth (24.0%), caesarean section (18.8%), preterm delivery (21.8%), and LBW (11.2%). Knowledge of specific developmental and health-related risks of suboptimal infant outcomes ranged between 18.0% and 46.5%. Logistic regression revealed that limited knowledge of maternal age-related pregnancy risks were associated with unplanned pregnancy (OR, 1.48; 95% CI, 1.03-2.14), smoking (OR, 1.83; 95% CI, 1.29-2.60) and non-use of fertility treatment (OR, 2.15; 95% CI, 1.44-3.19). Characteristics associated with limited knowledge of the risks associated with suboptimal birth outcomes were: age 35-39 years (OR, 2.98; 95% CI, 1.35-6.58), less than post-graduate education (

Abstract (French): Contexte : Une proportion croissante de bébés naissent de femmes de 35 ans et plus, lesquelles risquent davantage d'avoir des complications durant la grossesse et d'accoucher de nourrissons d'un poids sous-optimal. Notre étude visait : 1) à déterminer ce que les femmes savent au sujet de la procréation tardive, notamment des complications de la grossesse et des résultats associés à l'insuffisance de poids à la naissance (IPN, <2 500 g), à l'accouchement prématuré (<37 semaines) et à l'accouchement multiple, et 2) à évaluer les caractéristiques des femmes qui connaissent mal ces risques. Méthode : Nous avons mené un sondage téléphonique assisté par ordinateur auprès de 1 044 femmes, sélectionnées au hasard, ayant accouché d'un premier enfant vivant entre juillet 2002 et septembre 2003 dans deux centres urbains de l'Alberta (Calgary et Edmonton). Résultats : Les femmes connaissaient les risques de la procréation à un âge avancé dans les proportions suivantes : difficultés à concevoir (85,3 %), accouchement multiple (24 %), accouchement par césarienne (18,8 %), accouchement prématuré (21,8 %), et IPN (11,2 %). Entre 18 % et 46,5 % des répondantes connaissaient les risques développementaux et sanitaires auxquels est exposé un nouveau-né de poids sous-optimal. Une analyse de régression logistique a montré que la connaissance limitée des risques de la grossesse à un âge maternel avancé était associée à la grossesse non planifiée (RC = 1,48; IC de 95 % = 1,03-2,14), au tabagisme (RC = 1,83; IC de 95 % = 1,29-2,60) et au fait de ne pas avoir subi de traitement de l'infertilité (RC = 2,15; IC de 95 % = 1,44-3,19). Les caractéristiques associées à la connaissance limitée des risques de l'IPN étaient les suivantes : avoir entre 35 et 39 ans (RC = 2,98; IC de 95 % = 1,35-6,58), ne pas avoir fait d'études postsecondaires (moins qu'un diplôme d'études secondaires : RC = 2,14; IC de 95 % = 1,20-3,82), et ne pas être inscrite en tant qu'étudiante (RC = 1,75; IC de 95 % = 1,02-3,00). Conclusions : Nombre de femmes ont peu conscience des répercussions possibles de la procréation tardive. Il y aurait des lacunes à combler sur le plan du counselling et de l'éducation avant la grossesse pour favoriser une prise de décisions plus éclairée en matière de planning familial. [ABSTRACT FROM AUTHOR]

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المؤلفون: Göçmen, Ahmet, Fanlıkan, Fatih

المصدر: Case Reports in Obstetrics & Gynecology; 2013, p1-3, 3p

مصطلحات موضوعية: ROBOTICS, SURGICAL robots, CHILDBIRTH, HEALTH outcome assessment, PREMATURE labor, LAPAROSCOPIC surgery

مستخلص: Introduction. To report the robotic-assisted abdominal cerclage performed in two nonpregnant women and the success of live birth outcomes. Presentation of Cases. A 36-year-old woman with a complaint of recurrent second trimester pregnancy losses and a 35-year-old patient with a complaint of preterm deliveries and cervical insufficiency underwent robotic assisted abdominal cervicoisthmic cerclage placement in nonpregnant period. The two patients had spontaneous pregnancy after the robotic-assisted abdominal cerclage and delivered healthy infants. Discussion. The limitations of traditional laparoscopic abdominal cerclage have been accomplished with robotic surgery advantages especially intuitivemovements and increased range of motion. There are only a few studies in the literature including robotic assisted abdominal cerclage in nonpregnant women, and only five successful live birth outcomes were reported. In this paper, we reported the sixth and seventh cases of achieved live pregnancy after robotic assisted abdominal cerclage in the literature. Conclusion. Robotic assisted abdominal cerclage is a good alternative surgical method with successful pregnancy outcomes. [ABSTRACT FROM AUTHOR]

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المؤلفون: Berry, Katherine A., Baron, Ida Sue, Weiss, Brandi A., Baker, Robin, Ahronovich, Margot D., Litman, Fern R.

المصدر: American Journal of Obstetrics & Gynecology; Oct2013, Vol. 209 Issue 4, p356.e1-356.e6, 0p

مصطلحات موضوعية: HUMAN in vitro fertilization, NEUROPSYCHOLOGY, PREMATURE labor, HEALTH outcome assessment, EXECUTIVE function, DISEASES, PRESCHOOL children, CHILDBIRTH, MATERNAL age

مستخلص: Objective: In vitro fertilization (IVF) is considered a generally safe procedure, although associated with a higher incidence of preterm birth. The literature is inconsistent about the psychological impact of IVF, and we found no reports about outcome in late preterm (LPT) children. Our objective was to study neuropsychological and behavioral outcomes in a cohort of preschoolers born LPT between 2004 and 2007. Study Design: Participants were 397 LPT children (mean age, 3.8 years) conceived assisted by IVF (n = 105) or non-IVF (n = 292). Standardized performance-based tests of general conceptual ability (intelligence quotient), executive function, focused/selective attention, visual-spatial perception, visual-motor skill, manual dexterity, learning, and memory were administered. Parents completed behavioral and executive function questionnaires. Results: IVF group characteristics included older maternal age (P < .001), lower birthweight (P < .001), and higher maternal education (P < .001). No main-effect significant group differences were found for any variable after controlling for these variables. However, sex differences were demonstrated for the neuropsychological variables in copying (P > .001), nonverbal reasoning (P = .001), manual dexterity (P = .001), and inhibitory capacity (P = .006), all favoring girls. Conclusion: Birth following IVF-assisted conception did not increase the risk of intellectual, neuropsychological, or behavioral deficit in LPT preschoolers. As shown in earlier gestational-age participants, girls have selective advantages. These findings should be reassuring for parents who conceive through IVF and deliver infants 1-3 weeks before term gestational age. Future study of these children at elementary school age may detect subtle impairments not yet apparent at age 3 years. [Copyright &y& Elsevier]

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