Nicolaides K.H.,King's College London |
Syngelaki A.,King's College London |
Poon L.C.,King's College London |
De Paco Matallana C.,Hospital Universitario Virgen Of La Arrixaca |
And 7 more authors.
American Journal of Obstetrics and Gynecology | Year: 2016
Background Preterm birth is the leading cause of neonatal death and handicap in survivors. Although twins are found in 1.5% of pregnancies they account for about 25% of preterm births. Randomized controlled trials in singleton pregnancies reported that the prophylactic use of progestogens, cervical cerclage and cervical pessary reduce significantly the rate of early preterm birth. In twin pregnancies, progestogens and cervical cerclage have been shown to be ineffective in reducing preterm birth. Objective The objective of this study was to test the hypothesis that the insertion of a cervical pessary in twin pregnancies would reduce the rate of spontaneous early preterm birth. Study Design This was a multicenter, randomized controlled trial in unselected twin pregnancies of cervical pessary placement from 20+0-24+6 weeks' gestation until elective removal or delivery vs. expectant management. Primary outcome was spontaneous birth <34 weeks. Secondary outcomes included perinatal death and a composite of adverse neonatal outcomes (intraventricular haemorrhage, respiratory distress syndrome, retinopathy of prematurity or necrotizing enterocolitis) or need for neonatal therapy (ventilation, phototherapy, treatment for proven or suspected sepsis, or blood transfusion). Analysis was by intention to treat. This trial is registered in the ISRCTN registry, number 01096902. Results A total of 1,180 (56.0%) of the 2,107 eligible women agreed to take part in the trial; 590 received cervical pessary and 590 had expectant management. Two of the former and one of the latter were lost to follow up. There were no significant differences between the pessary and control groups in rates of spontaneous birth <34 weeks (13.6% vs. 12.9%; relative risk 1.054, 95% confidence interval [CI] 0.787-1.413; p=0.722), perinatal death (2.5% vs. 2.7%; relative risk 0.908, 95% CI 0.553-1.491; p=0.702), adverse neonatal outcome (10.0 vs. 9.2%; relative risk 1.094, 95% CI 0.851-1.407; p=0.524) or neonatal therapy (17.9% vs. 17.2%; relative risk 1.040, 95% CI 0.871-1.242; p=0.701). A post hoc subgroup analysis of 214 women with short cervix (≤25 mm) showed no benefit from the insertion of a cervical pessary. Conclusion In women with twin pregnancy, routine treatment with cervical pessary does not reduce the rate of spontaneous early preterm birth. © 2016 Elsevier Inc.
Gonzalez Gonzalez N.L.,Hospital Universitario Of Canarias |
Plasencia W.,Hospiten Global Care |
Gonzalez Davila E.,University of La Laguna |
Padron E.,Hospital Universitario Of Canarias |
And 3 more authors.
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2013
Objective: To determine the effect of using customized vs. standard population birthweight curves to define large for gestational age (LGA) infants. Methods: We analyzed data obtained from 2,097 singleton pregnancies using three different methods of classifying newborn birthweight: standard population curves, British or Spanish customized curves. We recorded maternal characteristics, proportion of LGA newborns when using each method, percentage of LGA according to one method but not for the others, and concordance between the different methods. Results: The proportion of LGA newborns according to Spanish customized curves was significantly lower than that calculated using either standard general population birthweight curves or British curves (p < 0.001). A third (33.9%) of the infants classified as LGA according to the general population method were adequate for gestational age (AGA) when the Spanish customized curves were used, and 18.5% of non-LGA were LGA according to customized curves (p < 0.001). Concordance between the different models high, but on excluding AGA the concordance coefficient was low (Cohen's κ <0.4). Conclusions: The use of customized curves allows differentiation between constitutional LGA and cases of fetal overgrowth, leading to a decrease in the rate of both false-positives and negatives as well as the overall proportion of LGA babies. © 2013 Informa UK, Ltd.
Belik J.,University of Toronto |
Gonzalez-Luis G.E.,Hospital Universitario Materno Infantil Of Canarias |
Perez-Vizcaino F.,Complutense University of Madrid |
Villamor E.,Maastricht University
Free Radical Biology and Medicine | Year: 2010
Isoprostanes are prostaglandin-like bioactive molecules generated via nonenzymatic peroxidation of lipid membrane-derived arachidonic acid by free radicals and reactive oxygen species. Their cognate receptors, biological actions, and signaling pathways are poorly understood. Aside from being sensitive and specific biomarkers of oxidative stress, E- and F-ring isoprostanes have important biological functions and likely mediate many of the disease-related pathological changes for which they are used as indicators. The biochemical pathways involved in isoprostane formation, their pathogenetic relevance to adult disease states, and their biological function are addressed. Developmentally, plasma and tissue content data show that isoprostane levels are highest during fetal and early neonatal life, when compared with adults. As such, the available data suggesting that isoprostanes play an important biological role, as well as possibly actively participate in the regulation of pulmonary vascular tone and the transition from fetal to postnatal life, are here reviewed. Lastly, the association between isoprostanes and certain neonatal clinical conditions is addressed. Although its existence has been recognized for almost 20 years, little is known about the critical importance of isoprostanes during fetal life and immediate neonatal period. This review is an attempt to bridge this knowledge gap. © 2009 Elsevier Inc. All rights reserved.
Plasencia W.,Fetal Medicine Unit |
Gonzalez Davila E.,University of La Laguna |
Tetilla V.,Hospital Universitario Materno Infantil Of Canarias |
Padron Perez E.,Hospital Universitario Of Canarias |
And 2 more authors.
Ultrasound in Obstetrics and Gynecology | Year: 2012
Objectives: To examine the relationship between newborn birth weight and first-trimester uterine artery (UtA) pulsatility index (PI), maternal characteristics, serum pregnancy-associated plasma protein-A (PAPP-A), free β-human chorionic gonadotropin (β-hCG) and fetal nuchal translucency (NT) thickness. We also examined the results of screening for large-for-gestational-age (LGA) neonates by an integrated first-trimester approach incorporating these parameters. Methods: We evaluated maternal characteristics, fetal NT, PAPP-A, free β-hCG and UtA-PI in 2097 singleton pregnancies at 11 + 0 to 13 + 6 weeks' gestation. Linear models based on quasi Akaike's Information Criterion were used to determine the best predictive model for fetal birth weight. The patient-specific risk of delivering an LGA infant was derived from multiple logistic regression analysis and the performance of screening was determined by receiver-operating characteristics curve analysis. Results: The best predictive models for fetal birth weight included UtA-PI, PAPP-A, NT, parity, maternal age, smoking status, weight, height and free β-hCG. In pregnancies delivering LGA newborns compared with non-LGA pregnancies, PAPP-A and NT thickness were significantly increased (P = 0.016 and 0.001, respectively) and UtA-PI was significantly decreased (P = 0.011). A combination of maternal factors with PAPP-A, fetal NT and UtA-PI identified 34.4% of LGA newborns for a false-positive rate of 10%. Conclusions: This study showed an association between newborn birth weight and maternal factors, and first-trimester PAPP-A, β-hCG, fetal NT and UtA-PI. Together, these factors can be used to identify over a third of pregnancies that will deliver LGA infants. Copyright © 2012 ISUOG.
Moonen R.M.J.,Maastricht University |
Moonen R.M.J.,Atrium Medical |
Reyes I.,Hospital Universitario Materno Infantil Of Canarias |
Cavallaro G.,University of Milan |
And 3 more authors.
PLoS ONE | Year: 2010
Background: A C-to-A nucleotide transversion (T1405N) in the gene that encodes carbamoyl-phosphate synthetase 1 (CPS1) has been associated with changes in plasma concentrations of L-arginine in term and near term infants but not in adults. In preterm infants homozygosity for the CPS1 Thr1405 variant (CC genotype) was associated with an increased risk of having necrotizing enterocolitis (NEC). Plasma L-arginine concentrations are decreased in preterm infants with NEC. Aim: To examine the putative association between the CPS1 T1405N polymorphism and plasma arginine concentrations in preterm infants. Methods: Prospective multicenter cohort study. Plasma and DNA samples were collected from 128 preterm infants (,30 weeks) between 6 and 12 hours after birth. Plasma amino acid and CPS1 T1405N polymorphism analysis were performed. Results: Distribution of genotypes did not differ between the preterm (CC:CA:AA = 55.5%:33.6%:10.9%, n = 128) and term infants (CC:CA:AA = 54.2%:35.4%:10.4%, n = 96). There was no association between the CPS1 genotype and plasma Larginine or L-citrulline concentration, or the ornithine to citrulline ratio, which varies inversely with CPS1 activity. Also the levels of asymmetric dimethylarginine, and symmetric dimethylarginine were not significantly different among the three genotypes. Conclusions: The present study in preterm infants did not confirm the earlier reported association between CPS1 genotype and L-arginine levels in term infants. © 2010 Moonen et al.
Goya M.,Autonomous University of Barcelona |
Pratcorona L.,Autonomous University of Barcelona |
Merced C.,Autonomous University of Barcelona |
Rodo C.,Autonomous University of Barcelona |
And 11 more authors.
The Lancet | Year: 2012
Background Most previous studies of the use of cervical pessaries were either retrospective or case controlled and their results showed that this intervention might be a preventive strategy for women at risk of preterm birth; no randomised controlled trials have been undertaken. We therefore undertook a randomised, controlled trial to investigate whether the insertion of a cervical pessary in women with a short cervix identified by use of routine transvaginal scanning at 20-23 weeks of gestation reduces the rate of early preterm delivery. Methods The Pesario Cervical para Evitar Prematuridad (PECEP) trial was undertaken in five hospitals in Spain. Pregnant women (aged 18-43 years) with a cervical length of 25 mm or less were randomly assigned according to a computer-generated allocation sequence by use of central telephone in a 1:1 ratio to the cervical pessary or expectant management (without a cervical pessary) group. Because of the nature of the intervention, this study was not masked. The primary outcome was spontaneous delivery before 34 weeks of gestation. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00706264. Findings 385 pregnant women with a short cervix were assigned to the pessary (n=192) and expectant management groups (n=193), and 190 were analysed in each group. Spontaneous delivery before 34 weeks of gestation was significantly less frequent in the pessary group than in the expectant management group (12 [6%] vs 51 [27%], odds ratio 0·18, 95% CI 0·08-0·37; p<0·0001). No serious adverse effects associated with the use of a cervical pessary were reported. Interpretation Cervical pessary use could prevent preterm birth in a population of appropriately selected at-risk women previously screened for cervical length assessment at the midtrimester scan.
Plasencia W.,Hospital Universitario Materno Infantil Of Canarias |
Garcia R.,Hospital Universitario Materno Infantil Of Canarias |
Pereira S.,King's College |
Akolekar R.,King's College |
And 2 more authors.
Fetal Diagnosis and Therapy | Year: 2011
Objective: To propose new cutoffs in plasma glucose levels in screening and diagnosis of gestational diabetes mellitus (GDM) in the first trimester of pregnancy. Methods: A 50-gram oral glucose challenge test (GCT) was performed in 1,716 singleton pregnancies at 6-14 weeks' gestation. In those with a positive GCT, a 100-gram glucose tolerance test (GTT) was carried out. The GCT and as necessary the GTT were repeated at 20-30 weeks. The relation of the results of the GCT and GTT at 6-14 weeks to that at 20-30 weeks was examined. Results: The diagnosis of GDM was made in 85 cases. In the GCT, there was a significant association between 1-hour plasma glucose levels at 6-14 weeks and at 20-30 weeks (r = 0.558, p < 0.0001), and in all cases of GDM, the level was 130 mg/dl or more at 6-14 weeks and 140 mg/dl or more at 20-30 weeks. In the GTT, the plasma glucose 1, 2 and 3 h after the 100-gram glucose load at 6-14 weeks was, respectively, 18, 29 and 35% lower than at 20-30 weeks. Conclusion: Effective diagnosis of GDM in the first trimester can be achieved by lowering the GCT and GTT plasma glucose cutoffs. Copyright © 2011 S. Karger AG, Basel.
Garcia Hernandez J.A.,Hospital Universitario Materno Infantil Of Canarias |
Madera Gonzalez D.,Hospital Universitario Materno Infantil Of Canarias |
Padilla Castillo M.,Hospital Universitario Materno Infantil Of Canarias |
Figueras Falcon T.,Hospital Universitario Materno Infantil Of Canarias
International Journal of Cosmetic Science | Year: 2013
Few studies have tested the efficacy of commercially available cosmetic products for preventing striae gravidarum. Therefore, the objective of this study was to evaluate efficacy on prevention of striae gravidarum using a specific anti-stretch mark cream containing hydroxyprolisilane-C, rosehip oil, Centella asiatica triterpenes and vitamin E. A randomized, double-blind, placebo-controlled trial was conducted between November 2009 and April 2011. Pregnant women were included and classified as treated group (emollient and moisturizer containing hydroxyprolisilane C, rosehip oil, Centella asiatica triterpenes and vitamin E) and control group (cream without the active ingredients). Overall incidence of stretch marks during pregnancy was 33.3% for the control group and 37.6% for the treated group (n.s.). Severity of previous stretch marks significantly increased in the control group during the study (17.8%, P = 0.001), but not in the treated group (6.3%, ns). In women who developed new stretch marks during the study, there was a significantly greater 'difference in severity' (between baseline and maximum severity) in control group vs. treated group (0.47 [0.57] vs. 0.14 [0.60], P = 0.031). In women without previous striae, incidence of these marks was significantly lower for the treated group patients compared with control group (5.6% vs. 35%, P = 0.031, OR: 9.2 [95% CI: 1.0-83.3]). The use of the anti-stretch mark product is proved to be effective in reducing severity of the striae during pregnancy, prevents the appearance of new striae and halts progression of those already present. In women who had no striae at baseline, use of the anti-stretch mark cream was more effective than placebo in preventing new stretch marks. © 2012 Society of Cosmetic Scientists and the Société Française de Cosmétologie.
Beltra Pico R.,Hospital Universitario Materno Infantil Of Canarias
Cirugía pediátrica : organo oficial de la Sociedad Española de Cirugía Pediátrica | Year: 2010
Excessive hand sweating, known as palmar hyperhidrosis, is a disabling disorder that starts during the childhood, and can have a strong negative impact on the quality of life of affected children, as they feel rejected by others due to their permanently damp hands, suffering during school activities, contact sports and daily games. Thoracoscopic sympathicolysis is easy to perform and has proven to be safe, with a short operating time. A review was performed on 48 children who underwent surgical treatment of palmar hyperhidrosis and answered a follow-up questionnaire to evaluate their level of satisfaction. Considering the final surgical results, the 48 patients were completely satisfied with the outcome of the operation. Significant complications or adverse effects were not detected. The primary palmar hyperhidrosis is a pathology that entails an important reduction in the quality of life of those who suffer it. With the results of this technique in hand, we recommend the endoscopic thoracic sympathicolysis procedure for the treatment of this pathology in paediatrics. The level of patient satisfaction was high.
Cansino Campuzano A.,Hospital Universitario Materno Infantil Of Canarias
Pediatria Integral | Year: 2012
Acute bronchitis is a diagnosis that is often performed although its definition is unclear. In general, the term is used for acute bronchitis, acute respiratory infection in which the predominant symptom is cough, with or without expectoration. Its etiology is viral in most cases and the treatment is basically supportive measures. Bronchiolitis, a lower respiratory tract infection that mainly affects the small airways (bronchioles), is a frequent cause of illness and hospitalization in infants that causes a great demand for care in all levels of care, primary care and hospital. Its etiology is viral and respiratory syncytial virus (RSV) is the most frequently isolated. It occurs in epidemics during winter and early spring. In most cases follows a benign self-limiting, presenting the most severe in younger infants and those with some risk factor. The clinical diagnosis is supported by the epidemiological environment. There is great variability in the therapeutic management of bronchiolitis among pediatricians, primary care is based on supportive measures and the use of a test dose of an inhaled bronchodilator.