perinatal outcomes

围产期结局
  • 文章类型: Journal Article
    目的:评估妊娠早期(≤12周)绒毛膜下出血(SCH)之间的关系,以及在辅助生殖技术(ART)帮助下受孕的妇女的母婴结局。
    方法:PubMed,Embase,WebofScience,我们在Scopus数据库中搜索了观察性研究,这些研究专门针对通过ART实现妊娠的女性,并调查了妊娠早期(妊娠12周内)SCH与母婴结局之间的关系.仅包括单胎妊娠的研究和比较组(无SCH的女性)的报告数据。感兴趣的主要结局包括早期(妊娠20周内)妊娠丢失的发生率,早产,剖腹产,和活产率。汇总效应大小以比值比(OR)和95%置信区间(CI)报告。
    结果:纳入9项研究。所有研究都有队列设计。在所有研究中,使用的主要辅助生殖技术是体外受精(IVF).与没有SCH的怀孕相比,诊断为早孕SCH的女性有类似的早产风险(<37周)(OR1.01,95%CI0.83,1.22),低出生体重(<2500g)(OR1.01,95%CI0.59,1.73)和胎儿生长受限(OR1.57,95%CI0.62,4.02)。两组的孕龄(周)(加权平均差(WMD)-0.06,95%CI-0.18,0.06)和出生体重(克)(WMD-16.5,95%CI-62.9,29.8)也相似。早期妊娠丢失的几率(OR1.39,95%CI0.97,2.01),两组的活产(OR0.77,95%CI0.55,1.08)和剖宫产(OR0.97,95%CI0.81,1.16)在统计学上相似.孕产妇不良结局的风险,如妊娠期糖尿病(OR0.98,95%CI0.74,1.29),高血压疾病(OR0.95,95%CI0.63,1.43),两组的胎膜早破(PROM)(OR1.36,95%CI0.90,2.05)和胎盘早剥(OR2.44,95%CI0.57,10.5)也相似.没有发表偏倚的证据。
    结论:研究结果表明,在通过ART受孕的妊娠中,SCH可能不会显着增加不良母婴结局的风险。尤其是IVF。
    背景:PROSPERO注册号CRD42024533996。
    OBJECTIVE: To evaluate the association between first trimester (≤ 12 weeks gestation) subchorionic hemorrhage (SCH), and maternal and neonatal outcomes in women who conceived with the help of assisted reproductive technique (ART).
    METHODS: PubMed, Embase, Web of Science, and Scopus databases were searched for observational studies that specifically focused on women who achieved pregnancy via ART and investigated the relationship between early pregnancy (within 12 weeks of gestation) SCH and maternal and neonatal outcomes. Only studies with singleton pregnancies and reporting data on the comparator group (women without SCH) were included. Primary outcomes of interest included incidences of early (within 20 weeks of gestation) pregnancy loss, preterm delivery, caesarean section, and live birth rates. Pooled effect sizes were reported as odds ratio (OR) with 95% confidence intervals (CI).
    RESULTS: Nine studies were included. All studies had a cohort design. In all studies, the primary assisted reproduction technique used was in-vitro fertilization (IVF). Compared to pregnancies without SCH, women with diagnosed early pregnancy SCH have a similar risk of preterm birth (< 37 weeks) (OR 1.01, 95% CI 0.83, 1.22), low birth weight (< 2500 g) (OR 1.01, 95% CI 0.59, 1.73) and fetal growth restriction (OR 1.57, 95% CI 0.62, 4.02). The gestational age (in weeks) (weighted mean difference (WMD) - 0.06, 95% CI - 0.18, 0.06) and the birth weight (in grams) (WMD - 16.5, 95% CI - 62.9, 29.8) were also similar in the two groups. The odds of early pregnancy loss (OR 1.39, 95% CI 0.97, 2.01), live birth (OR 0.77, 95% CI 0.55, 1.08) and caesarean delivery (OR 0.97, 95% CI 0.81, 1.16) were statistically similar in both groups. The risk of maternal adverse outcomes such as gestational diabetes (OR 0.98, 95% CI 0.74, 1.29), hypertensive disorder (OR 0.95, 95% CI 0.63, 1.43), premature rupture of membranes (PROM) (OR 1.36, 95% CI 0.90, 2.05) and placental abruption (OR 2.44, 95% CI 0.57, 10.5) was also similar in both the groups. There was no evidence of publication bias.
    CONCLUSIONS: The findings suggest that SCH may not significantly increase the risk of adverse maternal and perinatal outcomes in pregnancies conceived through ART, particularly IVF.
    BACKGROUND: PROSPERO registration number CRD42024533996.
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  • 文章类型: Journal Article
    前置胎盘对孕产妇和围产期健康构成重大风险,然而,它的管理仍然具有挑战性。这篇综合综述综合了目前有关前置胎盘孕产妇和围产期结局的证据,解决它的流行病学问题,病理生理学,诊断,和管理策略。前置胎盘会使怀孕复杂化,发病率的增加与高龄和剖宫产率上升等因素有关。产妇并发症,包括出血和胎盘植入谱系障碍,构成重大风险。同时,围产期结局的特点是早产率增加,宫内生长受限,以及新生儿发病率和死亡率。及时诊断和适当管理,包括产前皮质类固醇和多学科护理,对于优化结果至关重要。未来的研究应该集中在改进诊断方法上,评估新的干预措施,并评估长期神经发育结果。这篇综述强调了知情的临床实践和正在进行的研究工作的重要性,以提高受前置胎盘影响的妇女和婴儿的结局。
    Placenta previa poses significant risks to maternal and perinatal health, yet its management remains challenging. This comprehensive review synthesizes current evidence on maternal and perinatal outcomes in placenta previa, addressing its epidemiology, pathophysiology, diagnosis, and management strategies. Placenta previa complicates pregnancies, with increasing incidence linked to factors such as advanced maternal age and rising cesarean rates. Maternal complications, including hemorrhage and placenta accreta spectrum disorders, pose substantial risks. At the same time, perinatal outcomes are marked by increased rates of preterm birth, intrauterine growth restriction, and neonatal morbidity and mortality. Timely diagnosis and appropriate management, including antenatal corticosteroids and multidisciplinary care, are critical for optimizing outcomes. Future research should focus on improving diagnostic methods, evaluating novel interventions, and assessing long-term neurodevelopmental outcomes. This review underscores the importance of informed clinical practice and ongoing research efforts to enhance outcomes for women and infants affected by placenta previa.
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  • 文章类型: Journal Article
    乙型肝炎病毒感染在怀孕期间构成了重大挑战,因为垂直传播的风险会对孕产妇和新生儿的福祉造成严重后果。这项全面的审查深入探讨了围产期乙型肝炎感染的复杂性,阐明其对妊娠结局的影响,并强调在围产期护理的更广泛框架内解决这一问题的必要性。通过仔细检查当前的证据,诊断方法,管理技术,和预防措施,这篇综述强调迫切需要加强筛查方案,及时干预,和加强公共卫生举措。值得注意的是,主要发现强调了婴儿慢性乙型肝炎病毒(HBV)感染的可能性升高及其对母亲和新生儿健康的持久影响。当务之急是呼吁采取行动,倡导采取多方面的方法,参与医疗保健专业人士,政策制定者,和公共卫生机构优化管理和预防战略,从而努力改善孕妇及其受乙型肝炎病毒感染影响的婴儿的结局。
    Hepatitis B viral infection poses a significant challenge during pregnancy, as the risk of vertical transmission carries serious consequences for both maternal and neonatal well-being. This comprehensive review delves into the intricacies surrounding hepatitis B infection during the perinatal period, shedding light on its impact on pregnancy outcomes and stressing the necessity of addressing it within the broader framework of perinatal care. By scrutinizing current evidence, diagnostic methodologies, management techniques, and preventive measures, this review emphasizes the urgent need for enhanced screening protocols, timely interventions, and augmented public health initiatives. Notably, key findings underscore the elevated likelihood of chronic hepatitis B virus (HBV) infection in infants and its enduring implications for the health of both mothers and newborns. The imperative call to action advocates for a multifaceted approach, engaging healthcare professionals, policymakers, and public health agencies to optimize strategies for management and prevention, thereby striving for improved outcomes for pregnant women and their infants affected by hepatitis B viral infection.
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  • 文章类型: Journal Article
    妊娠胆汁淤积症(CP),或肝内CP(ICP),代表怀孕特有的一种情况,以胆汁酸流动受损和随后在母体血液中的积累为特征。主要出现在妊娠晚期,CP对母亲和胎儿都有相当大的风险,包括早产发生率升高,胎儿窘迫,和死产,伴随着母体并发症,如剧烈瘙痒和肝功能障碍。尽管具有临床意义,CP的病因,涉及遗传,荷尔蒙,和环境因素,仍然部分理解。这篇全面的综述深入研究了CP的生理学和病理生理学,概述其临床表现和诊断标准,并讨论了相关的母体和胎儿并发症。此外,它评估当前的管理策略,预后影响,以及对母婴健康的潜在长期影响。并探讨了未来的研究方向,强调需要改进对CP病理生理学的理解,开发新的治疗干预措施,改进风险分层模型。通过提供CP的全面概述,这篇综述旨在提高临床意识,指导管理实践,并确定需要进一步调查的区域,最终有助于改善受影响的妇女及其婴儿的健康结果。
    Cholestasis of pregnancy (CP), or intrahepatic CP (ICP), represents a condition peculiar to pregnancy, marked by impaired bile acid flow and consequent accumulation in the maternal bloodstream. Primarily emerging in the third trimester, CP is linked with considerable risks to both the mother and fetus, including heightened incidences of preterm birth, fetal distress, and stillbirth, alongside maternal complications such as intense pruritus and liver dysfunction. Despite its clinical significance, the etiology of CP, which involves genetic, hormonal, and environmental factors, remains partially understood. This comprehensive review delves into the physiology and pathophysiology of CP, outlines its clinical manifestations and diagnostic criteria, and discusses the associated maternal and fetal complications. Furthermore, it evaluates current management strategies, prognostic implications, and potential long-term effects on maternal and child health. It also explores future research directions, emphasizing the need for advancements in understanding the pathophysiology of CP, developing novel therapeutic interventions, and improving risk stratification models. By offering a thorough overview of CP, this review aims to enhance clinical awareness, guide management practices, and identify areas requiring further investigation, ultimately contributing to better health outcomes for affected women and their babies.
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  • 文章类型: Journal Article
    孤立的胎儿脑室增宽会产生一系列后果,从轻度神经发育延迟到围产期死亡;这些后果的程度通常取决于脑室增宽的严重程度。本系统评价和荟萃分析旨在研究从妊娠第15周开始诊断为孤立性胎儿脑室肥大的胎儿中,心室扩张程度对神经发育延迟和不良围产期结局风险的影响。
    PubMed,Embase,以电子方式搜索Scopus和Cochrane图书馆,以确定调查轻度和/或重度孤立胎儿脑室增宽预后的研究。如果他们报告了从妊娠15周及以后的产前诊断为孤立的胎儿脑室增宽的胎儿的神经发育或围产期结局,则纳入文章。如果研究报告了非孤立性脑室增宽(IVM),则将其排除在外,没有说明脑室增宽的程度,是非英语论文,动物研究或在21年的兴趣期之外发表。研究质量由两名独立评审员使用改良版本的纽卡斯尔-渥太华质量评估量表进行评估。当心室直径测量为10-15或>15mm时,将心室肥大定义为轻度或重度,分别。对不良神经发育结局进行了荟萃分析,胎儿宫内死亡和婴儿死亡。
    删除重复项之后,搜索产生了2452次引用,其中23项研究纳入,8项符合meta分析的条件.轻度和重度孤立性胎儿脑室增宽767例和347例,分别。在严重病例中,不良结果的发生率始终高于轻度病例。不良神经发育结果的相对风险,胎儿宫内死亡和婴儿死亡率为4.24[95%置信区间(CI):2.46-7.30],4.46(95%CI:1.64-12.11)和6.02(95%CI:1.73-21.00),分别,比较轻度和重度孤立的胎儿脑室增宽病例。
    不良神经发育和围产期结局的可能性,包括宫内和婴儿死亡率,与轻度孤立的胎儿脑室增宽相比,严重孤立的胎儿脑室增宽增加。
    UNASSIGNED: Isolated fetal ventriculomegaly can have a range of consequences, ranging from mild neurodevelopmental delay to perinatal death; the extent of these consequences often depend on the severity of ventriculomegaly. This systematic review and meta-analysis aims to investigate the impact of the degree of ventricular dilatation on the risk of neurodevelopmental delay and adverse perinatal outcomes in fetuses diagnosed with isolated fetal ventriculomegaly from gestational week 15 onwards.
    UNASSIGNED: PubMed, Embase, Scopus and the Cochrane Library were searched electronically to identify studies investigating the prognosis of mild and/or severe isolated fetal ventriculomegaly. Articles were included if they reported neurodevelopmental or perinatal outcomes in fetuses prenatally diagnosed with isolated fetal ventriculomegaly from week 15 of gestation and onwards. Studies were excluded if they reported on non-isolated ventriculomegaly (IVM), failed to specify the degree of ventriculomegaly, were non-English papers, animal studies or published outside of the 21-year period of interest. Study quality was assessed by two independent reviewers using a modified version of the Newcastle-Ottawa Quality Assessment Scale. Ventriculomegaly was defined as either mild or severe when ventricular diameter measured as 10-15 or >15 mm, respectively. Meta-analyses were conducted for adverse neurodevelopmental outcome, intrauterine fetal demise and infant mortality.
    UNASSIGNED: Following the removal of duplicates, the search yielded 2,452 citations, of which 23 studies were included and 8 were eligible for meta-analysis. There were 767 and 347 cases of mild and severe isolated fetal ventriculomegaly, respectively. Adverse outcomes were consistently reported at a higher rate in severe cases than mild. The relative risks of adverse neurodevelopmental outcome, intrauterine fetal demise and infant mortality were 4.24 [95% confidence interval (CI): 2.46-7.30], 4.46 (95% CI: 1.64-12.11) and 6.02 (95% CI: 1.73-21.00), respectively, upon comparison of mild versus severe cases of isolated fetal ventriculomegaly.
    UNASSIGNED: The likelihood of adverse neurodevelopmental and perinatal outcomes, including intrauterine and infant mortality, is increased in severe isolated fetal ventriculomegaly compared to mild isolated fetal ventriculomegaly.
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  • 文章类型: Journal Article
    背景:孕产妇HIV感染仍然是一个重要的全球健康问题,对围产期结局有潜在影响。强调早期干预以改善受感染母亲和婴儿的围生期和产后结局是一个有效的治疗问题。
    目的:综合分析与HIV感染相关的围产期结局,并评估现有文献中与HIV感染相关的不良反应。
    方法:对PubMed的全面搜索,MEDLINE,GoogleScholar于2013年至2023年9月进行,使用相关的MeSH术语。
    方法:纳入的研究包括原始研究,横截面,prospective,回顾性研究和观察性研究集中在孕产妇HIV感染的围产期结局.
    方法:选定的研究经过严格的数据收集和全面的质量检查,并遵守PRISMA指南。
    结果:来自巴西的九项符合条件的研究,中国,印度,马拉维,尼日利亚,坦桑尼亚,美国,加拿大也包括在内。这些研究一致表明,母体HIV感染与不良围产期结局有关。分析显示早产风险较高(OR1.57,95%CI:1.39-1.78),低出生体重(OR1.33,95%CI:1.18-1.49),在感染HIV的母亲所生的婴儿中,小于胎龄(OR1.38,95%CI:1.24-1.53)。值得注意的是,抗逆转录病毒治疗(ART)对这些结果的影响各不相同,但无论收入水平和地理区域如何,孕产妇HIV感染仍然是一个重要的危险因素.
    结论:孕产妇HIV感染与不良围产期结局始终相关,强调需要有针对性的干预措施和改善感染艾滋病毒的孕妇的产前护理。
    BACKGROUND: Maternal HIV infection remains a significant global health concern with potential repercussions on perinatal outcomes. Emphasis on early intervention to improve peri- and postnatal outcomes in infected mothers and infants is a valid therapeutic concern.
    OBJECTIVE: To comprehensively analyze perinatal outcomes associated with maternal HIV infection and evaluate adverse effects associated with the HIV infection in the existing literature.
    METHODS: A comprehensive search of PubMed, MEDLINE, and Google Scholar was conducted from 2013 to September 2023, using relevant MeSH terms.
    METHODS: The included studies encompassed original studies, cross-sectional, prospective, retrospective studies and observational studies focused on perinatal outcomes in the context of maternal HIV infection.
    METHODS: The selected studies underwent rigorous data collection and comprehensive quality checks and adhered to the PRISMA guidelines.
    RESULTS: Nine eligible studies from Brazil, China, India, Malawi, Nigeria, Tanzania, the USA, and Canada were included. These studies have consistently demonstrated that maternal HIV infection is associated with adverse perinatal outcomes. The analysis revealed a higher risk of preterm birth (OR 1.57, 95% CI: 1.39-1.78), low birth weight (OR 1.33, 95% CI: 1.18-1.49), and small for gestational age (OR 1.38, 95% CI: 1.24-1.53) among infants born to mothers living with HIV. Notably, the impact of antiretroviral treatment (ART) on these outcomes varied, but maternal HIV infection remained a significant risk factor regardless of income level and geographic region.
    CONCLUSIONS: Maternal HIV infection is consistently associated with adverse perinatal outcomes, emphasizing the need for targeted interventions and improved prenatal care in pregnant women with HIV infection.
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  • 文章类型: Journal Article
    在这篇系统综述和荟萃分析中,我们旨在回顾2019年冠状病毒病(COVID-19)感染孕妇新生儿的特征和结局.我们使用以下电子数据库进行了在线书目搜索:通过PubMed的MEDLINE,Scopus,WebofScience,和CochraneCentral.如果研究从确诊为COVID-19的母亲中招募新生儿,并报告新生儿COVID-19病例的围产期结局,则这些研究被认为是合格的。共纳入20项研究。COVID-19结果呈阳性的母亲所生的新生儿出生体重明显较低(平均差异,MD=-48.54g,p=0.04),胎儿窘迫的风险增加(比值比,OR=1.76,p<0.00001),呼吸窘迫(OR=1.96,p=0.006),早产(OR=2.08,p<0.00001),新生儿死亡(OR=2.20,p=0.004),和较低的5分钟Apgar评分(OR=1.44,p=0.02)。此外,他们更有可能入住新生儿重症监护病房(NICU)(OR=2.25,p=0.007),并且自身COVID-19检测呈阳性(OR=9.88,p=0.03).然而,其他参数,比如畸形的风险,机械通气,低血糖,和败血症,两组之间似乎具有可比性。孕妇在怀孕期间感染COVID-19与几种新生儿结局有关,其中一些是不利的,另一些则没有明显偏离规范。虽然我们的荟萃分析清楚地说明了与早产相关的风险增加,新生儿体重减轻,和其他挑战,它还强调,并非所有新生儿结局都可直接归因于孕产妇SARS-CoV-2感染.
    In this systematic review and meta-analysis, we aimed to review the characteristics and outcomes of the newborns of Coronavirus disease 2019 (COVID-19) infected pregnant women. We conducted an online bibliographic search using the following electronic databases: MEDLINE via PubMed, Scopus, Web of Science, and Cochrane Central. Studies were deemed eligible if they recruited newborns from mothers with confirmed COVID-19 and reported the perinatal outcomes of neonatal COVID-19 cases. A total of 20 studies were included. Neonates born to mothers with positive COVID-19 results have been shown to have significantly lower birth weights (mean difference, MD = -48.54 g, p = 0.04), increased risks of fetal distress (odds ratio, OR = 1.76, p < 0.00001), respiratory distress (OR = 1.96, p = 0.006), premature birth (OR = 2.08, p < 0.00001), neonatal death (OR = 2.20, p = 0.004), and a lower 5-minute Apgar score (OR = 1.44, p = 0.02). Additionally, they were more likely to be admitted to the neonatal intensive care unit (NICU) (OR = 2.25, p = 0.007) and test positive for COVID-19 themselves (OR = 9.88, p = 0.03). However, other parameters, such as risks for malformations, mechanical ventilation, hypoglycemia, and sepsis, appeared to be comparable between the two groups. Maternal infection with COVID-19 during pregnancy is associated with several neonatal outcomes, some of which are adverse and others that do not show significant deviation from norms. While our meta-analysis clearly illustrates heightened risks associated with premature birth, reduced neonatal weight, and other challenges, it also emphasizes that not all neonatal outcomes can be directly attributed to maternal SARS-CoV-2 infection.
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  • 文章类型: Journal Article
    背景:腹部成形术是一种常见的身体轮廓手术,用于去除多余的脂肪和皮肤,并恢复因衰老而减弱或分离的腹部肌肉,怀孕,或体重波动。关于腹部成形术后患者和妊娠结局的文献很少。我们试图确定不良妊娠结局与腹部成形术史之间是否存在相关性。
    方法:我们使用了一个大型的联邦去识别的国家健康研究网络,其数据来自美国68个医疗保健组织(TriNetX,数据于2022年8月19日访问)。使用ICD-10/9代码识别所有有妊娠记录的患者,并将其分为有腹部成形术史的患者和没有腹部成形术史的患者。我们评估了胎儿生长受限的围产期结局,异常脐动脉多普勒,妊娠期高血压,先兆子痫,早产,早产胎膜破裂,妊娠期糖尿病,巨大儿,死产,异常胎盘,以及腹部成形术后患者怀孕期间发生的伤口破裂/感染。进行倾向匹配以解释潜在的混杂因素。<0.05的α水平被认为是统计学上显著的。
    结果:在符合我们标准的44,737名患者中,304有腹部成形术史,而44,433没有(对照)。我们发现有腹壁成形术史的患者妊娠率明显较高,大部分位于南部和中西部地区,阴道分娩和剖宫产的次数更多,与对照组相比(表1)。在倾向得分匹配后,我们发现腹壁成形术患者先兆子痫和PPROM的风险较低(OR[95CI]=0.46[0.32,0.67],p<0.0001,表2)。此外,腹壁成形术与早产风险增加相关(OR[95CI]=2.15[1.48,3.13],p=0.0002,表2)。我们没有发现其他围产期结局的显着差异(表2)。
    结论:我们的数据表明,腹壁成形术可能与早产和剖宫产率的相对增加有关。但其他围产期结局并未增加.这提供了证据,表明未来的怀孕愿望不必是腹部成形术的相对禁忌症。
    Abdominoplasty surgery is a common body contouring surgery to remove excess fat and skin and restore weakened or separated abdominal muscles caused by aging, pregnancy, or weight fluctuations. There is limited literature regarding patient and pregnancy outcomes after abdominoplasty.
    This study aimed to determine whether there was a correlation between adverse pregnancy outcomes and history of abdominoplasty.
    Our study used a large federated deidentified national health research network with data sourced from 68 healthcare organizations within the United States (TriNetX; data accessed on August 19, 2022). All patients with a record of pregnancy were identified using the International Classification of Diseases, Ninth Revision and Tenth Revision, codes and were grouped into those with a history of abdominoplasty and those without. This study evaluated the perinatal outcomes of fetal growth restriction, abnormal umbilical artery Dopplers, gestational hypertension, preeclampsia, preterm delivery, preterm premature rupture of membranes, gestational diabetes mellitus, macrosomia, stillbirth, abnormal placentation, and wound disruption or infection occurring during a patient\'s pregnancy after abdominoplasty. Propensity matching was performed to account for potential confounders. An alpha level of <.05 was considered statistically significant.
    Of the 44,737 patients meeting our criteria, 304 had a history of abdominoplasty, whereas 44,433 did not (control). Our study found that patients with a history of abdominoplasty had significantly higher gravidity, were largely located in the Southern and Midwest region, and had higher counts of vaginal deliveries and cesarean deliveries than the control cohort (Table 1). After propensity score matching, our study found a lower risk of preeclampsia and preterm premature rupture of membranes in patients with abdominoplasty (odds ratio, 0.46; 95% confidence interval, 0.32-0.67; P<.0001) (Table 2). Furthermore, abdominoplasty was associated with an increased risk of preterm delivery (odds ratio, 2.15; 95% confidence interval, 1.48-3.13; P=.0002) (Table 2). Lastly, this study did not find significant differences in the other perinatal outcomes (Table 2).
    Our data suggest that abdominoplasty may be associated with a relative increase in the rates of preterm delivery and cesarean delivery and that other perinatal outcomes are not increased. This provides evidence that future desire for pregnancy need not be a relative contraindication to abdominoplasty.
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  • 文章类型: Journal Article
    目的:我们进行了系统评价和荟萃分析,以检查死胎与后续妊娠中各种围产期结局之间的关系。
    方法:PubMed,Cochrane图书馆,Embase,WebofScience,和CNKI数据库被搜索到2023年7月。
    方法:队列研究报告了死胎与后续妊娠围产期结局之间的关联。
    方法:我们根据PRISMA指南进行了系统评价和荟萃分析。使用R和STATA软件进行统计学分析。我们使用随机效应模型来汇集每个感兴趣的结果。我们进行了荟萃回归分析以探索潜在的异质性。证据评估的确定性(质量)采用GRADE方法。
    结果:纳入了19项队列研究,涉及4,855,153名参与者。从这些研究中,我们确定了28,322例先前死产的个体符合资格标准。在调整了混杂因素后,低到中等确定性的证据表明,与先前在随后的怀孕中有活产的妇女相比,先前有死胎的妇女有更高的复发性死胎风险(OR:2.68,95%CI:2.01至3.56),早产(OR:3.15,95%CI:2.07至4.80),新生儿死亡(OR:4.24,95%CI:2.65至6.79),SGA/IUGR(OR:1.3,95%CI:1.0至1.8),低出生体重(OR:3.32,95%CI:1.46至7.52),胎盘早剥(OR:3.01,95%CI:1.01至8.98),仪器交付(OR:2.29,95%CI:1.68至3.11),引产(OR:4.09,95%CI:1.88至8.88),剖腹产(OR:2.38,95%CI:1.20至4.73),选择性剖腹产(OR:2.42,95%CI:1.82至3.23),和紧急剖腹产(OR:2.35,95%CI:1.81至3.06),但自然分娩率较低(OR:0.22,95%CI:0.13至0.36)。然而,既往死胎与后续妊娠中的先兆子痫无相关性(OR:1.72,95%CI:0.63~4.70).
    结论:我们的系统评价和荟萃分析提供了更全面的了解与先前死产相关的不良妊娠结局。这些发现可用于为考虑在先前的死产后生孩子的夫妇提供咨询。
    We conducted a systematic review and meta-analysis to examine the relationship between stillbirth and various perinatal outcomes in subsequent pregnancy.
    PubMed, the Cochrane Library, Embase, Web of Science, and CNKI databases were searched up to July 2023.
    Cohort studies that reported the association between stillbirth and perinatal outcomes in subsequent pregnancies were included.
    We conducted this systematic review and meta-analysis in accordance with the PRISMA guidelines. Statistical analysis was performed using R and Stata software. We used random-effects models to pool each outcome of interest. We performed a meta-regression analysis to explore the potential heterogeneity. The certainty (quality) of evidence assessment was performed using the GRADE approach.
    Nineteen cohort studies were included, involving 4,855,153 participants. From these studies, we identified 28,322 individuals with previous stillbirths who met the eligibility criteria. After adjusting for confounders, evidence of low to moderate certainty indicated that compared with women with previous live births, women with previous stillbirths had higher risks of recurrent stillbirth (odds ratio, 2.68; 95% confidence interval, 2.01-3.56), preterm birth (odds ratio, 3.15; 95% confidence interval, 2.07-4.80), neonatal death (odds ratio, 4.24; 95% confidence interval, 2.65-6.79), small for gestational age/intrauterine growth restriction (odds ratio, 1.3; 95% confidence interval, 1.0-1.8), low birthweight (odds ratio, 3.32; 95% confidence interval, 1.46-7.52), placental abruption (odds ratio, 3.01; 95% confidence interval, 1.01-8.98), instrumental delivery (odds ratio, 2.29; 95% confidence interval, 1.68-3.11), labor induction (odds ratio, 4.09; 95% confidence interval, 1.88-8.88), cesarean delivery (odds ratio, 2.38; 95% confidence interval, 1.20-4.73), elective cesarean delivery (odds ratio, 2.42; 95% confidence interval, 1.82-3.23), and emergency cesarean delivery (odds ratio, 2.35; 95% confidence interval, 1.81-3.06) in subsequent pregnancies, but had a lower rate of spontaneous labor (odds ratio, 0.22; 95% confidence interval, 0.13-0.36). However, there was no association between previous stillbirth and preeclampsia (odds ratio, 1.72; 95% confidence interval, 0.63-4.70) in subsequent pregnancies.
    Our systematic review and meta-analysis provide a more comprehensive understanding of adverse pregnancy outcomes associated with previous stillbirth. These findings could be used to inform counseling for couples who are considering pregnancy after a previous stillbirth.
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  • 文章类型: Journal Article
    背景:现役军人和退伍军人占美国军队的近20%,可能会经历兵役特有的创伤。军事创伤包括战斗部署和军事性创伤,暴露于可能导致创伤后应激障碍(PTSD)。这项范围审查的目的是检查军事创伤暴露对现役军人和退伍军人的妊娠结局的影响程度。
    方法:对OVIDMEDLINE的系统搜索,OVIDEmbase,和OVIDPsycINFO从开始到2023年9月25日,确定了研究军事创伤暴露与围产期结局之间关联的研究。在确定的614项研究中,464次进行了相关性审查,16符合纳入标准。
    结果:在纳入的16项研究中,14发现军事创伤暴露与包括早产在内的不良妊娠结局之间存在关联,妊娠期糖尿病,妊娠高血压疾病,低出生体重,围产期情绪和焦虑症。不良妊娠结局的风险随着PTSD的严重程度而增加,战斗部署的最近,重复部署。
    结论:这项范围审查加强了创伤暴露与现任和前任军人的不良妊娠结局之间的联系。关于现役军人的创伤暴露,文献中仍然存在差距,这与女性退伍军人有很大不同。由于精神健康状况是孕产妇死亡的主要根本原因,建议在围产期对该人群进行标准化筛查,以检测军事创伤暴露和创伤后应激障碍.初级入伍的黑人女性在PTSD诊断和不良妊娠结局方面承担着不成比例的负担。全面的产前和产后管理可以改善军人妇女的围产期和新生儿结局,并提供一种减少现有种族差异的创新方法。
    BACKGROUND: Active-duty servicewomen and veterans make up nearly 20% of the United States military and may experience trauma specific to military service. Military-specific trauma includes combat deployment and military sexual trauma, exposure to which may result in posttraumatic stress disorder (PTSD). The purpose of this scoping review is to examine the extent to which military trauma exposures impact the pregnancy outcomes of active-duty servicewomen and women veterans.
    METHODS: A systematic search of OVID MEDLINE, OVID Embase, and OVID PsycINFO from inception to September 25, 2023, identified studies examining associations between military trauma exposures and perinatal outcomes. Of the 614 studies identified, 464 were reviewed for relevance, with 16 meeting inclusion criteria.
    RESULTS: Of the 16 included studies, 14 found associations between military trauma exposure and adverse pregnancy outcomes including preterm birth, gestational diabetes, hypertensive disorders of pregnancy, low birth weight, and perinatal mood and anxiety disorders. The risks of adverse pregnancy outcomes increased with the severity of PTSD, the recency of combat deployment, and repetitive deployment.
    CONCLUSIONS: This scoping review strengthens the link between trauma exposures and adverse pregnancy outcomes for current and former military servicewomen. A gap in the literature persists regarding trauma exposure among active-duty servicewomen, which differs significantly from women veterans. As mental health conditions are the leading underlying cause of maternal mortality, standardized screening during the perinatal period for military-specific trauma exposures and PTSD is recommended for this population. Black servicewomen of junior enlisted rank carry disproportionate burdens of PTSD diagnosis and adverse pregnancy outcomes. Comprehensive prenatal and postpartum management may improve perinatal and neonatal outcomes for military servicewomen and provide an innovative approach to reducing existing racial disparities.
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